When Dr. Jack Kevorkian was constructing the suicide machine that would help Janet Adkins kill herself in 1990, he gave it a name which he thought described its function: the mercitron. It seems a strange name for a machine which manufactures death; but Kevorkian isn't the only one to use the name "mercy" to describe his trade. The popular term for physicians helping terminally ill patients to commit suicide is "mercy-killing." And there seems to be widespread consensus that when doctors assist some patients with suicide, they are doing a compassionate work. It's a new consensus detected by pollsters: According to a 1991 Roper poll surveying people in California, Oregon, and Washington, 60 percent say the law should be changed so doctors can legally help patients with suicide. And whereas 15 years ago, 53 percent of Americans said that suicide was always wrong, that figure now hovers at only 41 percent.
But, along with the growing acceptance, even welcoming, of euthanasia and physician-assisted suicide, have come increasingly dire warnings about the practice from ethicists and thinkers. Such prominent names as former Surgeon General C. Everett Koop, the late award-winning novelist Walker Percy, and the Jewish-Christian ethical group the Ramsey Colloquium have all explicitly warned that the new welcoming of euthanasia is a phenomenon fraught with danger. According to all three, the "mercy" offered by euthanasia can only be offered by those who, logically and emotionally, hold to a conception of the human person radically different from that of traditional medicine: the price of accepting euthanasia's "compassion" is denying that humans have any inherent worth apart from their productivity or utility. As Walker Percy says, such "tenderness" leads inevitably "to the gas chamber"-to societies in which the scope for "mercy killings" swells to include not only the terminally ill, but those deemed socially useless as well.
This warning was perhaps most forcefully given by the Ramsey Colloquium, a periodic gathering of prominent Jewish and Christian ethicists and thinkers. In the wake of a November 1991 referendum in the state of Washington to decriminalize physician-assisted suicide-a referendum that came within 4 percentage points of victory-the group published a "Declaration on Euthanasia" to help fight the trend towards growing toleration of the practice. The Declaration reads in part.
...Euthanasia is contrary to our faith as Jews and Christians, is based upon a grave moral error, does violence to our political tradition, and undermines the integrity of the medical profession....In relating to the sick, the suffering, the incompetent, the disabled and the dying, we must learn again the wisdom that teaches us always to care and never to kill. Though it sometimes seems compassionate, killing is never a means of caring.
For those involved in the Ramsey Colloquium, too, the "compassion" leading to mercy-killing is the first step towards a society in which the integrity of all life is abandoned.
For most Americans it may still seem a long way from supporting a right for voluntary euthanasia for the terminally ill to a society where all respect for life is abandoned. Advocates of euthanasia, in fact, often argue that it is precisely their deep respect for human life that allows them to support suicide for the terminally ill. "No decent human being would allow an animal to suffer without putting it out of its misery," argues renowned author Isaac Asimov in a critic's blurb for the bestselling suicide manual Final Exit. "It is only to human beings that human beings are so cruel as to allow them to live on in pain, in hopelessness, in living death, without moving a muscle to help them."But what is the nature of this help that only supporters of euthanasia claim to be able to give?
All doctors are bound by their Hippocratic oath-and by the nature of their profession itself-to strive their utmost to alleviate suffering in their patients. Advocates of euthanasia argue that in some cases, the only remedy that can ease pain is one only they are willing to prescribe: death. Describing his client's most recent case of assisted suicide, Michael Schwartz, the lawyer for Dr. Jack Kevorkian, said the doctor was simply alleviating suffering in the only way left. "This is a case of medicine. It is a situation where the object was to alleviate the pain and suffering for patients who wish to have that pain and suffering put to an end."
This may have provided an argument in favor of assisted suicide ten or fifteen years ago. But medical advances in the area of pain control now allow doctors to so completely soothe intense suffering that this argument for accepting euthanasia has become virtually useless. Advances in such devices as morphine drips and treated skin patches effectively guarantee that no terminally ill patient will suffer a painful death. According to Professor Robert Spitzer, a philosopher and authority on medical ethics: "Such significant advances have been made in the last two or three years by pain control experts that now it can be said with assurance that you will almost certainly not die an agonizing death. It can be said with assurance that total pain control may be had in the vast majority of the diseases leading to death." Dr. Cecily Saunders, the founder of the modern hospice movement, argues that advances in pain control management have made the euthanasia option completely unnecessary.
Strangely enough, even advocates of physician-assisted suicide admit that traditional medicine can eliminate virtually all pain. Derek Humphry, author of Final Exit, amazingly concedes that doctors can eliminate virtually all pain for those who are terminally ill: "Certainly, modern pharmaceutical developments have provided us with wonderful analgesics, which, with shrewd management, control terminal pain in about 90 percent of the cases." Even the most ardent supporters of a right to physician-assisted suicide admit their campaign is about far more than the relief of physical suffering.
If traditional medicine can now soothe the frayed nerves of the terminally ill and calm their broken bodies, what then is the appeal of euthanasia? Humphry gives the answer, one that should give pause to all who hold that euthanasia is solely about the relief of physical suffering.
[I]t is not just pain, or fear of pain, that drives people into the arms of the euthanasia movement. It is the symptoms of an illness, and often the side effects of medication, that damage the quality of people's lives...[A] person may not wish to live with throat cancer after the tongue has been removed and the face disfigured; or...if reading or watching television is the great comfort of life, loss of sight is a tremendous blow if added to the knowledge that death is impending. According to Humphry, doctors assisting in suicide are not just relieving unbearable physical agony. More importantly, they are claiming to end the psychic pains that often attend illness: the pain that can beset those who lose their beauty, their hobbies, their ability to be productive in the world.
Sources of human worth
In the traditional schema in which Western medicine was practiced, doctors did not have to worry about "curing," via euthanasia or anything else, a patient's diminishing value or worth-and that for the simple reason that the patient's value did not diminish, no matter how ravaged by illness or disease he or she might be. Human value, human worth, was not a product of some utilitarian calculus, which could be measured according to how active or talented or useful a person was. The intrinsic worth of each person was seen to be a simple given, a fact, inhering in that person for no other reason than that he or she was a creature made in the image and likeness of God.
Again and again in the foundation documents of Western society, we are brought face to face with the insistent doctrine that a person's worth is divinely given rather than socially conferred. It is a doctrine found both at the very beginning of the Christian and Jewish scriptures:
God created man in His image; In the divine image He created him; male and female He created them; (Genesis 1:27)
and in the document marking the establishment of what would later become the United States of America, our Declaration of Independence:
We hold these truths to be self-evident. That all men are created equal, endowed by their Creator with certain unalienable rights...
It is a concept that takes on special significance for Christians. For the follower of Christ, not only do all people have value apart from their social function or usefulness: It is precisely those who are least esteemed in the human community with whom Jesus identifies Himself:
For I was hungry and you gave Me food, thirsty and you gave Me drink. I was a stranger and you welcomed Me, naked and you clothed Me, in prison and you came to visit Me. (Matthew 25: 35-36)
But this valuing of persons in themselves is not exclusive to Christians. In a speech on euthanasia, Professor Spitzer points out that even classical philosophy recognizes that a person' s worth is not defined by his function, but simply by his loving of the good:
For a moment we might think that we ought to produce, that by producing our lives have meaning. "Nay!" say the philosophers. By loving, by sensing the good, by being good as best we can, by trying to lead others to the good, trying to help others through the muck of life, and above all by sensing the good in the other and bonding them to ourselves-there we will find life's meaning.
The literature of virtually all the peoples of the world echoes the sentiment more humbly. It rings out with exhortations at least for hospitality, for welcoming the stranger in one's midst. Since the stranger is one who by definition has no value within the new community, this near-universally acknowledged precept reveals that human value is seen as having another source.
This, then, is the political tradition to which the Ramsey Colloquium refers, the one which euthanasia does "violence" to by its very nature. Euthanasia depends for its very raison d'etre on the assertion that our value can be diminished by an impairing of our ability to be active or productive. It's an assertion that flies in the face of thousands of years of Western tradition
What are the consequences of bucking the long-standing tradition that human value is inherent in the person, not a product of functionality? Ethicists are unanimous in predicting such a shift in values will extend the scope of cases in which euthanasia will be seen as legitimate. Former Surgeon General C. Everett Koop has this to say:
I am convinced that in the 1930s the German medical sentiment favoring euthanasia (even before Hitler came to power) made it easier for the Nazi government to move society along the slippery slope that led to the Holocaust. The German euthanasia movement started with defective babies, then reached out to eliminate the insane, then to those suffering from senile dementia, then to patients with advanced tuberculosis, to amputees deemed of no further service to the Reich, to gypsies, to Poles, and finally to Jews. The Holocaust was upon us.
Walker Percy similarly draws an analogy between the culture of euthanasia and the culture that spawned Nazism:
In a word, certain consequences, perhaps unforeseen, follow upon the acceptance of the principle of the destruction of human life for what may appear to be the most admirable social reasons.
One does not have to look back very far in history for an example of such consequences. Take democratic Germany in the 1920s. Perhaps the most influential book published in German in the first quarter of this century was entitled The Justification of the Destruction of Life Devoid of Value. Its co-authors were the distinguished jurist Karl Binding and the prominent psychiatrist Alfred Hoche. Neither Binding nor Hoche had ever heard of Hitler or the Nazis.
Nor, in all likelihood, did Hitler ever read the book. He didn't have to. The point is that the ideas expressed in the book were the product not of Nazi ideology but rather of the best minds of the pre-Nazi Weimar Republic-physicians, social scientists, jurists, and the like, who with the best secular intentions wished to improve the lot, socially and genetically, of the German people-by getting rid of the unfit and the unwanted....[O]nce the line is crossed, once the principle is accepted- juridically, medically, socially-innocent human life can be destroyed for whatever reason...[I]t is not difficult to imagine an electorate or a court ten years, fifty years from now, who would favor getting rid of useless old people, retarded children, antisocial blacks, illegal Hispanics, gypsies, Jews...
The language of Koop and Percy, and their analogy, are dramatic: they see a philosophical continuum between the culture that allows euthanasia and the culture that ultimately produced Nazi Germany. But the analogy is not far-fetched. Even doctors and ethicists who are not vehemently opposed to physician-assisted suicide in all cases worry that its legalization will lead to mounting pressure on the poor or crippled to choose it as an option-even if, left to themselves, they'd prefer life. Nancy Dubler and David Nimmons wonder: "If a patient were poor, would caregivers struggle so hard to control disease and pain if they had the option to end it all [through euthanasia]? And Dr. Timothy Johnson, a medical editor for ABC News and a limited supporter of physician- assisted suicide, states that a clear danger of increased acceptance of euthanasia is "inappropriate pressure to terminate life for financial, family, or societal reasons that are not consonant with the best interest of the person..."
Real world scenarios
Those who are reluctant to accept the historical or logical arguments for euthanasia expanding its scope need only look at current events, particularly as they play out in the Netherlands, where euthanasia, though technically illegal, is officially tolerated.
Right now in Holland 3 percent of all deaths are directly caused by doctors. If that same percentage applied in the United States, deaths caused by doctors would amount to 64,860 a year. What is more, according to a poll conducted by the Dutch government and released September 10, 1991, Dutch physicians now are performing two-and-one-half times more involuntary euthanasia than voluntary. Involuntary euthanasia-murder-is still illegal in Holland, and the Dutch doctors register these deaths on death certificates as heart attacks or some other ailment. But according to a study by the Dutch government itself, the physicians are performing them-at two-and-a-half times the rate they perform the tolerated voluntary euthanasia.
Were euthanasia to be tolerated in other countries as it is in Holland, we could look for similar results. Already, pollsters have found that 90 percent of economics students support compulsory euthanasia for unspecified groups of people to "streamline the economy." And even if such students fail in enacting laws actually mandating euthanasia, we have seen how the pressure already exists for the weak and unwanted to succumb. Some have already detected that pressure in action: of the first six people Dr. Jack Kevorkian helped to commit suicide, all were middle-aged women. Some ethicists explain this by saying that contemporary society makes women in particular feel unwanted and useless, subtly encouraging them to choose death. "The wording that is used very often by these women is that they don't want to be a burden," says Rachel MacNair, president of Feminists for Life of America.
Such reports are leading more and more ethicists to remark that the slide down the slippery slope of assisted-suicide to active euthanasia in Holland is just a few years away from taking place here in America. As Professor Spitzer writes
If this progression of events can occur in Holland, why couldn't such a progression of events occur in the U.S? Once physicians suddenly see there is this easy way out, once they see there is no necessity of moving through the unpleasantness of telling somebody that they have to die, then why shouldn't they work to make euthanasia mandatory? This logic is leading even now to a culture that, in its zeal to erase suffering, will eradicate our humanity, our value, and ultimately our capacity to love. For Professor Spitzer and for others, the prognosis is not good:
This last scenario represents the total decline of culture. It is the epitome of a culture that no longer recognizes love or goodness to be the value of life. It is a culture that values only one thing: convenience, function, some kind of production beyond consumption. That is a crass utilitarian culture. And that is the culture we are trying to prevent.
 As reported in Ethics On Call, by Nancy Dubler and David Nimmons. Crown Publishing, 1992, p.l67.
 This is the theme of Percy's last novel, The Thanatos Syndrome, Farrar, Straus, Giroux, 1987. See especially pp.358-362.
 Taken from the February, 1992 issue of Crisis magazine.
 "'Dr. Death' aids cancer patient with her suicide," Associated Press, Nov. 24, 1992.
 "A Reason to Die: Euthanasia comes to Washington State," Crisis magazine, October 1991, p.21.
 Final Exit, Derek Humphry. Dell, 1992, p.134.
 Ibid., pp. 21-22.
 "A Reason To Die: Euthanasia Comes To Washington State," op.cit., p.22.
 Let's Talk: An Honest Conversation On Critical Issues, C. Everett Koop and Timothy Johnson. Zondervan, 1992, p.46.
 Signposts in a Strange Land, Walker Percy, ed. Patrick Samway. Farrar, Straus, Giroux, 1991. "An Unpublished Letter to the Times," pp.350-1.
 Ethics On Call, op. cit., p.172.
 Let's Talk, op. cit., p.44.
 Let's Talk, op.cit., p.54.
 "A Reason to Die: Euthanasia Comes to Washington State," op.cit., p.45.
 "Three Choices For Death," E. Catherine Moroney. America, November 21, 1992, p. 402.
 "Kevorkian draws criticism from medical ethicists," The Washington Times, Nov. 28, 1992.
 "A Reason To Die," p.45.
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